Delayed healing wounds cause morbidity, interfere with quality of life, create hardship for the patients, and create economic strain on the health care system. Skin biopsies are often necessary for diagnosis via histopathology examination and formation of treatment plan. Especially in the chronic wound condition, skin-punch biopsy provides evidence based on individual wound care. Debridement is crucial to wound healing. A slow healing wound tends to collect dead tissue or debrides (devitalized tissue may be eschar that is dry or leathery or slough that is soft and brown, grey, or yellow). The presence of necrotic or compromised tissue is common in chronic non-healing wounds.
Devitalized tissue provides a growth medium for bacteria, increasing infection risk and inflammation due to the influx of cytotoxic cells and products. The presence of cytotoxic cells and bacteria results in the release of fibroblasts and keratinocytes to the wound. Necrotic tissue prevents formation of granulation tissue, wound contraction, and epithelialization.
Chronic wounds are mired in a chronic inflammatory state, exhibiting markedly elevated pro-inflammatory cytokines, matrix metalloproteases, and excessive neutrophils. This persistent inflammatory state may be explained as the consequence of biofilm—chronic bacterial infection. The presence of compromised or necrotic tissue is common in chronic, non-healing wounds. The devitalized tissue provides a growth medium for bacteria, increases the risk of infection. Devitalized tissue releases endotoxins that inhibit migration of fibroblasts and keratinocytes to the wound, prevent the formation of granulation tissue, wound contraction, and epithelialization, are mired in a chronic inflammatory state exhibiting elevated pro-inflammatory cytokine, matrix metalloproteases, and excessive neutrophiles.
Debridement is the most effective modality to physical removal and suppression of biofilm reformation. However, complete eradication of biofilm with debridement is a major barrier for wound healing. Acute wounds may only require a single debridement; chronic wounds often require repeated debridement as slough continuous to reappear. Currently, there is no suitable chronic wound model to standardize the chronic wound debridement, especially for residencies or junior physicians training in wound care clinics.
With debridement being such an important technique necessary for wound care, it remains necessary to continually develop new training methods and models for providing surgical residents with test subjects.